Yeah that's not very ambiguous! It's also not incredibly surprising. Tharrim is belatedly remembering that, one, Kalorm did not have an empty stomach when they last checked his stomach contents (which was, to be fair, an hour and a half ago, but to be equally fair, that was an hour and a half after they gave him a pretty modest amount of pure sugar water to try digesting, it's not surprising if he still hasn't made much more progress) and two, he has a definite tendency to push himself physically to the point where his body starts freaking out about it. 

Tharrim always keeps a vomit bag in a particular pocket of his scrubs; when it comes up urgently, you don't really want to have to cross the room to the supply cabinet for it. About 1.5 seconds later he's slapping it into Merrin's hand.

[Stay with him] he subvocalizes to her. She doesn't need to be told the other things, like "keep him calm" and "make sure he doesn't fall off the bed face-first". He has a portable console hooked to his belt, programmed to remotely control all of Kalorm's essential machines; he toggles the ventilator to patient-initiated-only mode so it won't be confused if Kalorm wants to breathe with weird timing, bumps up the inspiratory pressure support and decreases the baseline support, and flips on the two-minutes-of-100%-oxygen programming to help keep Kalorm's oxygenation up, and temp-pauses most of the alarms. To the other medtech, still hovering on the opposite side of the bed: [Nausea meds and toss me the gastric suction] 

(It's inconveniently unhooked right now, to minimize the number of trailing tubes they needed to manage for this. The gastric tube itself is capped, clamped, and pinned neatly out of the way to Kalorm's pajamas.) 

Merrin does not incredibly have enough hands for this but she'll manage! Kalorm's feet are still planted in his booties, and she'll perch half on the bed and wedge her knee in front of his knee to stop him from sliding forward, and awkwardly stretch her arm under his chest to stop him from falling over. She gets the vomit bag open one-handed. 

"- Kalorm, don't try to hold the bag, I've got it." He isn't nearly coordinated enough to help, at least not usefully. "Hold the bar and lean on my arm - that's it - deep breaths - we're getting your stomach emptied with the tube and giving you the medication, you'll feel better in thirty seconds." She would, like, rub his back reassuringly or something, if she had enough HANDS, which she does NOT. 

Yeah no thirty seconds is way too long. 

Kalorm is pretty unhappy! But - less miserable than he expected? Sitting up and bent over is just, like, a vastly more reasonable position if one is going to vomit, he has no idea why everyone seemed to think that "lying on his side" was correct before. He actually has something in his stomach, and while throwing up weird sweet water mixed with stomach acid is not his favorite sensory experience of all time, it's way less bad than what he remembers previously. It hurts a lot less, too. The chest incision is bothering him less in general, and clenching his abdominal muscles no longer feels like it's crushing his insides. His body is kindly giving him a chance to breathe between rounds of heaving (and this isn't absurdly hard - in this one moment, at least, he's really grateful for the breathing tube and the ventilator, which is also being surprisingly polite about not shoving air in him when he's BUSY). 

And after probably less than thirty seconds - though it's a very long thirty seconds - his stomach seems to decide that the problem, which definitely feels like an "exercised too hard after eating, like a dumbass" sort of problem and not a "probably dying" sort of problem, is now resolved. He's dizzy and sweaty and feels weak and shaky, but he's otherwise...fine? 

He stays bent over and leaning against Merrin's arm, because he does not especially trust his stomach right now. Besides, the dizziness doesn't really incline him to try sitting up, and also his mouth tastes horrible and spitting is inconveniently hard with the stupid breathing tube in the way. 

He manages to nod, or at least move his head in a nodding-ish way, when Merrin asks if he's feeling better. 

This position is awkward and Kalorm is HEAVY and Merrin's arm is really tired. Understandable of him not to feel like moving just yet, though! She'll wait for Tharrim to, uh, figure out what Kalorm needs now, because she really doesn't have enough hands to do anything other than what she's doing right now. 

Yep! Tharrim can kneel on the floor on Kalorm's other side, and offer him a cloth to wipe his face and then a water-spraying thingy along with the oral suction to rinse his mouth. He lets Kalorm do most of it himself. 

Honestly Kalorm is EXHAUSTED now and his hands don't really want to do things, but he can manage to wipe his own face, that's way better than the alternative.

He...is not very competent at holding the water-spraying thingy, and definitely can't hold two things at once and put both of them in his mouth without stabbing himself in the uvula. He's going to do them one at a time, and probably dribble on the floor. 

That's fine. Tharrim puts down a towel. 

Aaaaaand that was like ninety seconds of sitting with his head down. "Kalorm," he says gently. "Ready to lie down? We'll do all the work for you, and then you can rest properly." 

Mrrrrrrrrrrggggggggggggokay. Kalorm is really tired and does not incredibly want to move but he will agree that this is a bad position to sleep in. 

They have three experienced medtechs and a harness on him. They can get him back into the bed and comfortably positioned without Kalorm contributing anything to the process. 

Merrin undoes the buckles and magnetic fastenings and slides the harness off herself, even though it's slightly awkward as a one-person task, because she can pretty easily predict that Kalorm is VERY DONE with having multiple people touching him. She puts the bedrails back up.

"Warm blanket?" 

Sleepy nod. He was so hot before but now he's cold. 

It's probably because he sweated straight through his pajamas, but Merrin isn't going to subject him to bathing and changing them right now. "You did great. It would maybe at some point be nice if you stopped pushing yourself to the point of misery, but if that's how you want to do rehab then it's your prerogative." 

Kalorm was sort of expecting everyone to be mad at him for being inconvenient? He raises his eyebrows and makes a very dubious face without, actually, opening his eyes. 

Merrin flomps down into a chair. "I mean, if you push yourself to the point that it's medically dangerous, then one, we'll stop you, and two, we will have a serious talk about it afterward where I explain why it's dangerous. If you'd ignored that you were feeling faint right until you passed out and then fallen, we would be having a serious talk right now. But your vital signs were fine and you weren't at risk of aspirating, so it seems like the main effect was just you having a miserable time? And, I mean, it makes me sad when my patients are having a miserable time! If you would rather avoid it then I am absolutely here to help with that! When we try that again I think we'll make sure you have an empty stomach and give you the nausea medication first. But, like, I've done sprints until I puked and I didn't like it but I don't regret it and it's sort of no one's business except mine?" 

Merrin is the best person in the entire world, and Kalorm manages a very drowsy smile at her before his body decides that now is no longer the awake time. 

Merrin is a WEIRD ALIEN who is giving their patient POSSIBLY DUBIOUS ADVICE but, well, Tharrim can recognize that the dubious advice has its upsides. Which are that Kalorm is probably way more likely now to listen if Merrin actually intervenes and stops him from doing something medically dangerous. 

Anyway, they did come in almost exactly at last night's 50% estimate for when Kalorm would be standing! The rehab markets being calibrated on their patient's progress feels good. 

It DOES! Rehab experts are very pleased about this! His balance and coordination is also looking better this morning, at least for the lying-to-sitting, which he's practiced exactly twice. 

They're not by default recommending that he do another session of standing today. His leg strength is clearly not the main limitation, and the exercises they want him to do to train core stability and motor planning are better done sitting on the edge of the bed or in a specialized chair (the back and arms are adjustable, and entirely removable, so they can provide varying amounts of support and balance-assistance without Kalorm having to do anything too exhausting for the transitions). Doing a stand-and-pivot to the chair is probably a good next thing for him to try? He can sit up as long as he wants (with the chair in its most comfortable supportive-armchair mode), which will be good for his lungs. 

He's almost certainly not going to be walking 5 meters first thing tomorrow, even if he makes it off the ventilator. But they're actually pretty hopeful that he can get as far as, like, a couple of steps? And once he figures out the balance and coordination, he almost certainly isn't going to be bottlenecked on his leg muscle strength or stamina. The 20% / 50 % / 80% spread on getting him to assisted walking >5 meters is now 32 hours / 45 hours / 56 hours. For walking 50 meters unassisted (needing a cane or using a wall to balance doesn't count as "assistance" for this purpose), 4 days / 5 days / 7 days. 

Pulmonary experts are somewhat less delighted with Kalorm's morning minimum settings trial, but it's a positive sign that, while standing, he did totally fine on 50% oxygen. He was getting breath volumes of nearly 1000 ml without any extra pressure support, and his oxygenation was actually better than it tends to be when he's supine. They're also reviewing his routine lung ultrasound imaging, and they're hopeful about tonight. They actually suggest that he tries his next minimum settings trial while in the supportive-chair rather than the bed; it's pretty relevant that, as he regains more mobility, he'll be able to shift himself into whatever position makes breathing easiest for him.

The spread for getting him extubated is now 7 hours / 11 hours / 22 hours, with 60% odds that he'll need noninvasive positive pressure ventilation while asleep and 35% that he'll need it while awake. For getting off supplementary oxygen entirely, 72 hours / 4 days / 7 days. 

The fact that Kalorm will apparently exert himself to the point of vomiting is not, like, a great sign for advancing his diet, but for clear fluids it mostly means they'll want to be careful about timing, more closely ration how much he's given at once, and maybe keep the nasogastric tube longer than they might otherwise even if it's clamped. If he does come off the ventilator tonight, and he's alert and can swallow ice chips without choking, the nutrition team is comfortable letting him try some cautious sips of water, and moving on to juice a couple of hours after that (just not immediately before he does any intense rehab exercises, please.) The spread on Kalorm tolerating clear fluids is now 12 hours / 24 hours / 32 hours. For getting significant nutrition by mouth, 36 hours / 60 hours / 4 days. 

Okay but when will he be able to eat COOKIES, Merrin is getting kind of self-conscious about carrying the entire cookie burden here

The Diagnostic markets (and the nutrition team with Treatment Planning) have Merrin COVERED. Thousands of words of backchannel discussion have been exchanged about different cookie recipes and which cookie is probably easiest to digest. 

It's plausibly going to depend a lot on whether Kalorm ends up experiencing significant food aversions, which are very common in patients who've had a serious GI issue and been off solid food for weeks. A lot of patients end up preferring "food" that is not very foodlike and involves the bare minimum of eating-related sensory experiences like chewing. And with the type of enteral nerve damage and resulting misregulation that Kalorm experienced, solid food tends to be a lot more challenging and likely to cause delayed stomach emptying, acid reflux, or just unpleasant gassiness. 

But Merrin did challenge Kalorm to eat cookies as part of the deal when he challenged her to eat cookies! Merrin has been heroically holding up her end of the cookie pact! And by then there's inevitably going to have been a lot of buildup to it. Surely Kalorm will not be able to say no when someone finally presents him with a cookie and it's Merrin's turn to watch. 

(Night shifts in particular are boring. Various staff already have plans in motion for cookie-related side projects to keep themselves awake and amused.) 

Anyway, probably a (very digestively inoffensive) low-fiber plain sugar cookie can be Kalorm's first reintroduction to solid food? And the 20% / 50% / 80% predictions on when Kalorm will be ready for that are now sitting at 6 days / 11 days / 14 days. 

(Treatment Planning, subdivision: gastrointestinal and nutrition, is having so much fun right now.) 

Cute???????? 

(Well, maybe Merrin is not going to emphasize - or bring up - the amount of optimization that went into selecting a cookie menu for Kalorm, since he will predictably find that aspect of things irritating.) 

But: Kalorm might get to eat his cookies in LESS THAN A WEEK!!!!!!! This is one of the best days of Merrin's entire life!!!! 

(This kind of sidechannel inside joke is actually going on most of the time, usually in more than one location. It usually doesn't impact Merrin, who is rarely bored at work and definitely doesn't have time to be following all the prediction market discussion in real time.) 

Kalorm, loaded up with extra nausea meds, sleeps right through his noon antibiotic and a routine bedside chest X-ray (not as thorough as a CT but much less radiation, and can still track major changes). Despite having been supine for a while, while resting he's oxygenating fine on 40% O2. 

You know what? Things are going well, and Merrin thought she slept enough last night but apparently the caffeine cookies are not quite holding her up today. She's going to go curl up in her pod and at least attempt to take a NAP. 

(With the earplugs, even. She's still worried the white noise machine will annoy Kalorm, if not the other staff, but there's almost certainly not going to be an emergency, and if Kalorm is asking for her then she does, in fact, trust the staff to wake her for it.) 

When Kalorm wakes up at around 1:30, Tharrim is there! Holding headphones! Merrin is nowhere in sight. 

Kalorm is SUSPICIOUS. He glares at Tharrim.